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Gestational and Postpartum Sleep Apnea: Exhaled Nitric Oxide as a Biomarker in a Predictive Model
Abstract Number: GM-04
Abstract Type: Original Research
Objective: To determine prevalence of obstructive sleep apnea (OSA) in the third trimester and postpartum. To evaluate the utility of exhaled nitric oxide (exNO) when added to screening tools (Mallampati score, pregnancy specific score described by Facco et al) in predicting OSA during pregnancy.
Study Design: Prospective cohort using overnight Watch-PAT200® to diagnose OSA and morning, single breath NIOX-MINO® to evaluate exNO at 32-35 6/7 weeks gestation and again at 6-15 weeks postpartum in women delivering at Forsyth Medical Center. OSA was defined as an apnea-hypopnea index (AHI) of ≥5 . We also measured Facco score, Mallampati score, neck circumference, responses to a Berlin Questionnaire and medical and obstetric data.
We tested the hypothesis that prevalence of OSA does not change postpartum using an exact McNemar's test. A generalized estimating equation (GEE) was used to examine the difference in exNO in pregnancy in women with and without OSA. A multivariable logistic regression was used to determine the utility of exNO, Facco score, and Mallampati score as risk factors for OSA in pregnancy.
Results: Of 63 participants with valid data for both time points, the proportion testing positive for OSA in the third trimester (38%) did not differ from that postpartum (36%; p > .99).
GEE showed a significant effect of time (p=0.039) and a time x exNO interaction (p=0.024) for presence of OSA and utility as a biomarker only during pregnancy (Fig 1). Of the 72 participants with valid data during pregnancy, ExNO (odds ratio (95% CI): 1.139 (1.021, 1.270), p=.019 and Facco score (odds ratio (95% CI): 1.041 (1.006, 1.077), p=.020 were significant independent risk factors for OSA . After controlling for confounding effects, the odds of testing positive for OSA increases by 14% for each part per million increase in exNO and 4.1% for each 1 unit increase in Facco score. Mallampati score did not add to the utility of the model (p=.607). The model had modest discrimination with an area under the ROC curve (95% CI) of .751 (.632, .870), sensitivity of .654 and specificity of .659.
Conclusion: OSA is as common in the postpartum period as late in pregnancy. ExNO shows promise as a biomarker for OSA in pregnancy, particularly when combined with simple historical and observational data.